Low ejection fraction. Exercise to treat heart failure. Risk factors, symptoms. Heart ejection fraction rate Low cardiac output

22.09.2020 Insulin

Symptoms of the indicator going beyond normal limits, principles of treatment and prognosis.

The ejection fraction (EF) is the ratio of the stroke volume (blood that enters the aorta in one contraction of the heart muscle) to the end-diastolic volume of the ventricle (blood that accumulates in the cavity during the period of relaxation, or diastole, of the myocardium). This value is multiplied by 100% and the final value is obtained. That is, this percentage blood, which pushes the ventricle during systole, from the total volume of fluid contained in it.

The indicator is calculated by the computer during the ultrasonographic examination of the cardiac chambers (echocardiography or ultrasound). It is used only for the left ventricle and directly reflects its ability to perform its function, that is, to provide adequate blood flow throughout the body.

Under conditions of physiological rest, the normal value of EF is considered to be 50-75%, with physical activity in healthy people it rises to 80–85%. There is no further increase, since the myocardium cannot eject all the blood from the ventricular cavity, which will lead to cardiac arrest.

In the medical plan, only a decrease in the indicator is assessed - this is one of the main criteria for the development of a decrease in the working capacity of the heart, a sign of contractile myocardial insufficiency. This is evidenced by the value of EF below 45%.

Such insufficiency poses a great danger to life - a small supply of blood to the organs disrupts their work, which ends with multiple organ dysfunction and, as a result, leads to the death of the patient.

Considering that the reason for the decrease in the left ventricular ejection volume is its systolic insufficiency (as the outcome of many chronic pathologies heart and blood vessels), it is impossible to completely cure this condition. Treatment is carried out that supports the myocardium and is aimed at stabilizing the state at one level.

The observation and selection of therapy for patients with low ejection fraction is the responsibility of cardiologists and therapists. Under certain conditions, the assistance of a vascular or endovascular surgeon may be required.

Features of the indicator

The ejection fraction does not depend on the sex of the person.
Celebrate with age physiological decline indicator.
Low ejection fraction may be an individual norm, but less than 45% is always considered pathological.
An increase in the value is in all healthy people with an increase in heart rate and level blood pressure.
The norm of the indicator when carrying out measurements by radionucleic angiography is considered to be 45–65%.
For measurement, use the formulas of Simpson or Teicholz, normal values, depending on the method used, fluctuate up to 10%.
Critical level a decrease of 35% or less is a sign of irreversible changes in myocardial tissues.
For children in the first years of life, more high standards 60-80%.
The indicator is used to determine the prognosis of any cardiovascular disease in patients.

Reasons for the decrease in the indicator

At the initial stages of any disease, the ejection fraction remains normal due to the development of adaptation processes in the myocardium (thickening of the muscle layer, increased work, restructuring of small blood vessels). As the disease progresses, the capabilities of the heart exhaust themselves, there is a violation of the contractility of muscle fibers, and the volume of ejected blood decreases.

All influences and diseases that have a negative effect on the myocardium lead to such violations.

Acute myocardial infarction

Cicatricial changes in the heart tissue (cardiosclerosis)

Painless form of ischemia

Tachy and bradyarrhythmias

Ventricular wall aneurysm

Endocarditis (changes in the inner lining)

Pericarditis (bursa disease)

Congenital disorders of the normal structure or defects (violation of the correct location, a significant decrease in the lumen of the aorta, pathological connection between large vessels)

Aneurysm of any part of the aorta

Aortoarteritis (damage by cells of their own immunity of the walls of the aorta and its branches)

Pulmonary thromboembolism

Diabetes mellitus and impaired glucose absorption

Hormone-active tumors of the adrenal glands, pancreas (pheochromocytoma, carcinoid)

Stimulating narcotic drugs

Symptoms of a decrease in the indicator

Low ejection fraction is one of the main criteria for cardiac dysfunction; therefore, patients are forced to significantly limit their work and physical activity. Often, even simple household chores cause a deterioration, which makes you spend most of the time sitting or lying in bed.

The manifestations of a decrease in the indicator are distributed according to the frequency of occurrence from the most frequent to the rarer:

significant loss of strength and fatigue from the usual stress;
violation of breathing by the type of increase in frequency, up to attacks of suffocation;
breathing problems worse when lying down;
collaptoid states and loss of consciousness;
changes in vision (darkening in the eyes, "flies");
pain syndrome in the projection of the heart of varying intensity;
an increase in the number of heart contractions;
swelling of the legs and feet;
accumulation of fluid in the chest and abdomen;
a gradual increase in the size of the liver;
progressive weight loss;
episodes of impaired coordination and gait;
periodic decrease in sensitivity and active mobility in the limbs;
discomfort, moderate pain syndrome in the projection of the abdomen;
unstable stools;
bouts of nausea;
vomiting mixed with blood;
blood in the stool.

Treatment with a decrease in the indicator

The ejection fraction less than 45% is a consequence of changes in the functionality of the heart muscle against the background of the progression of the underlying disease-cause. A decrease in the indicator is a sign of irreversible changes in myocardial tissues, and about the possibility complete cure speech is out of the question. Everything therapeutic measures are aimed at stabilizing pathological changes in their early stage and improving the patient's quality of life - at a later date.

The complex of treatment includes:

correction of the main pathological process;
therapy of left ventricular failure.

This article is devoted directly to left ventricular ejection fraction and the types of its violation, therefore, further we will focus only on this part of the treatment.

Drug correction

Basic drugs

Improving the nutrition of the heart tissue

Increasing myocardial resistance to stress

Reliable increase in the efficiency of the heart muscle

Decrease in heart rate

Reducing the processes of natural death of heart cells in conditions of increased work

Increase in the number of zones with active contraction in the myocardium

Removing excess fluid and reducing the load on the myocardium

Reducing the volumetric load on the myocardium

Increased conductivity in conditions of impaired myocardial function

Additional funds

Protection of blood vessels in conditions of altered blood flow

Prevention of the formation of clots in the background venous stasis

Ancillary drugs

Improving blood flow in the heart vessels

Surgical correction

Installation of pacemakers or cardiovector-defibrillators for life-threatening disorders heart rate.
Resynchronization therapy - stimulation of the contraction of the ventricles and atria in different rhythms (slowing down the contraction of the ventricles by creating an artificial heart block).

Non-drug correction

Normalization of nutrition in accordance with the needs of the body to stabilize normal weight.
Dosed, but mandatory physical activity.
Normalization of the work-rest regime.
Psychotherapeutic assistance.
Physiotherapy and reflexology.

Forecast

If the left ventricular ejection fraction decreases, being in the range of 40–45%, the risk of death due to cardiac arrest is about 10–15%.
A decrease to 35-40% increases this risk to 20-25%.
Further decrease in the indicator in geometric progression worsens the prognosis for patient survival.

There is no complete cure for pathology, but the therapy started on time allows you to prolong life and maintain its relatively satisfactory quality.

What does normal, low and increased ejection fraction of the heart mean?

Before diagnosing a patient with chronic heart failure, the doctor conducts diagnostics with the obligatory determination of such an indicator as the ejection fraction. It reflects the amount of blood that the left ventricle pushes into the aortic lumen at the time of its contraction. That is, through such a study, it is possible to find out whether the heart is effectively coping with its work or there is a need to prescribe heart medications.

PV rate

To assess the work of the heart, namely the left ventricle, the Teicholz or Simpson formulas are used. It must be said that it is from this department that the blood enters the general circulation and with left ventricular failure, the clinical picture of heart failure most often develops.

The closer this indicator is to the norm, the better the main "motor" of the body is reduced and the more favorable the prediction for life and health. If the obtained value is much lacking to the norm, then it can be concluded that the internal organs do not receive the required amount of oxygen and nutrients from the blood, which means that the heart muscle must be somehow supported.

The calculation is carried out directly on the equipment on which the patient is examined. In modern rooms for ultrasound diagnostics, preference is given to the Simpson method, which is considered more accurate, although the Teicholz formula is used no less often. The results of both methods can vary by up to 10%.

Ideally, the ejection fraction should be 50-60%. According to Simpson, the lower bound is 45%, and according to Teicholz, 55%. Both methods differ enough high level informativeness regarding the possibilities of the myocardium to reduce. If the obtained value fluctuates between 35-40%, they speak of advanced heart failure. And even lower rates are fraught with fatal consequences.

Causes of EF decrease

Low values can be caused by pathologies such as:

Cardiac ischemia. In this case, the blood flow along coronary arteries decreases.
History of myocardial infarction. This leads to the replacement of normal heart muscles with scars, which do not have the necessary ability to contract.
Arrhythmia, tachycardia and other ailments that disrupt the rhythm of the body's main "motor" and conduction.
Cardiomyopathy. It consists in an increase or lengthening of the heart muscle, which is caused by hormonal failure, prolonged hypertension, heart defects.

Symptoms of the disease

A diagnosis of decreased ejection fraction can be made based on symptoms specific to the disease. Such patients often complain of attacks of shortness of breath, both during physical exertion and at rest. Breathlessness can be triggered by prolonged walking, as well as performing the simplest chores around the house: washing floors, cooking.

In the process of impaired blood circulation, fluid retention occurs, which leads to the appearance of edema, and in severe cases, they affect internal organs and tissues. The person begins to suffer from abdominal pain on the right side, and stagnation venous blood in the vessels of the liver can be fraught with cirrhosis.

These symptoms are characteristic for a decrease in the contractile function of the main "motor" of the body, but it often happens that the level of the ejection fraction remains normal, so it is very important to be examined at least once a year and do echocardioscopy, especially for people with heart disease.

An increase in EF to 70–80% should also be alarming, since this may be a sign that the heart muscle cannot compensate for the growing heart failure and tends to throw as much blood as possible into the aorta.

As the disease progresses, the LV function will decrease, and it is echocardioscopy in dynamics that will allow you to catch this moment. A high ejection fraction is typical for healthy people, in particular, athletes in whom the heart muscle is sufficiently trained and is able to contract with greater force than that of an ordinary person.

Treatment

It is possible to increase the reduced EF. For this, doctors use not only drug therapy, but also other methods:

Prescribe drugs to improve myocardial contractility. These include cardiac glycosides, after which there is a noticeable improvement.
To prevent overloading the heart with excess fluid, they are encouraged to follow a diet with restriction of table salt to 1.5 g per day and fluid intake to 1.5 liters per day. Along with this, diuretic drugs are prescribed.
Prescribe the intake of organoprotective agents that help protect the heart and blood vessels.
Make a decision about a surgical operation. For example, valve replacement is performed, shunts are installed on coronary vessels, etc. However, an extremely low ejection fraction may become a contraindication to surgery.

Prophylaxis

Prevention to prevent the development of heart disease is of great importance, especially in children. In the age of high technologies, when most of the work is performed by machines, as well as the constantly deteriorating environmental conditions of life and improper nutrition, the risk of developing heart ailments increases significantly.

Therefore, it is very important to eat right, play sports, and visit fresh air... It is this lifestyle that will ensure the normal contractility of the heart and muscle fitness.

The information on the site is provided for informational purposes only and is not a guide to action. Do not self-medicate. Please consult your healthcare professional.

FV ACCORDING TO TEHOLDS AND SIMPSON.

According to Simpson, the results are considered more reliable. EF 46% is not low, but slightly reduced. After such an illness, complications, surgery, the outcome should be considered very good. And the average survival time in CHF, as in any other disease, can serve as reliable criteria only in relation to a group of patients. For individuals deviations from the mean are so great that they completely lose their predictive value. I'm not sure that CONCOR should be taken twice a day, it works during the day and we usually prescribe it once a day.

The method for calculating the PV by any method is not without errors. So, you can find manuals in which the normal EF starts at 55%, at 50%, and even at 45%.

In this case, EF is low NORMAL!

Here is THIS tag: "CHF II A, FC II" does not have any diagnostic and prognostic value at all. Often, doctors frivolously glue all these traditional bells and whistles to diagnoses.

Ejection fraction of the heart

Inge Elder was not mistaken in suggesting the use of ultrasound for imaging human organs in the 1950s. Today, this method plays an important and sometimes key role in the diagnosis of heart disease. Let's talk about decoding its indicators.

1 An important diagnostic method

Ultrasound examination of the heart

Echocardiographic examination of cardio-vascular system is a very important and, moreover, a fairly accessible diagnostic method. In some cases, the method is the "gold standard", allowing you to verify a particular diagnosis. In addition, the method allows you to identify latent heart failure, which does not manifest itself during intense physical exertion. Echocardiographic data ( normal performance) may vary slightly depending on the source. We present the guidelines proposed by the American Echocardiography Association and the European Association for Cardiovascular Imaging from 2015.

2 Ejection fraction

Healthy ejection fraction and pathological (less than 45%)

The ejection fraction (EF) is of great diagnostic value, as it allows one to assess the systolic function of the LV and right ventricles. The ejection fraction is the percentage of blood volume that is expelled into the vessels from the right and left ventricles during the systole phase. If, for example, 65 ml of blood has entered the vessels from 100 ml of blood, this will be 65% as a percentage.

Left ventricle. The norm of the left ventricular ejection fraction in men is ≥ 52%, for women - ≥ 54%. In addition to the LV ejection fraction, an indicator of the LV shortening fraction is also determined, which reflects the state of its pumping (contractile function). The norm for the shortening fraction (FU) of the left ventricle is ≥ 25%.

Low left ventricular ejection fraction can be observed in rheumatic heart disease, dilated cardiomyopathy, myocarditis, myocardial infarction, and other conditions leading to the development of heart failure (weakness of the heart muscle). A decrease in left ventricular FU is a sign of LV heart failure. FU of the left ventricle decreases in heart diseases that lead to heart failure - myocardial infarction, heart defects, myocarditis, etc.

Right ventricle. The norm of the ejection fraction for the right ventricle (RV) is ≥ 45%.

3 Dimensions of the chambers of the heart

The size of the chambers of the heart is a parameter that is determined in order to exclude or confirm overload of the atria or ventricles.

Left atrium. The norm of the diameter of the left atrium (LA) in mm for men is ≤ 40, for women ≤ 38. An increase in the diameter of the left atrium may indicate heart failure in the patient. In addition to the LA diameter, its volume is also measured. The norm of LA volume for men in mm3 is ≤ 58, for women ≤ 52. The LA size increases with cardiomyopathies, defects mitral valve, arrhythmias (heart rhythm disturbances), congenital heart defects.

Right atrium. For the right atrium (RP), as well as for the left atrium, the size (diameter and volume) is determined by echocardiography. Normally, the diameter of the PCB is ≤ 44 mm. The volume of the right atrium is divided by the body surface area (BSA). For men, the normal ratio is the volume of PP / PPT ≤ 39 ml / m2, for women - ≤33 ml / m2. The size of the right atrium can increase with failure of the right heart. Pulmonary hypertension, thromboembolism pulmonary artery, chronic obstructive pulmonary disease and other diseases can cause the development of right atrial failure.

ECHO Cardiography (ultrasound of the heart)

Left ventricle. For the ventricles, their own parameters have been introduced regarding their sizes. Since the practicing physician is interested in functional state ventricles in systole and diastole, there are corresponding indicators. The main indicators of dimensions for the LV:

Diastolic size in mm (men) - ≤ 58, women - ≤ 52;
Diastolic size / PPT (men) - ≤ 30 mm / m2, women - ≤ 31 mm / m2;
End diastolic volume (men) - ≤ 150 ml, women - ≤ 106 ml;
End-diastolic volume / PPT (men) - ≤ 74 ml / m2, women - ≤61 ml / m2;
Systolic size in mm (men) - ≤ 40, women - ≤ 35;
End systolic volume (men) - ≤ 61 ml, women - ≤ 42 ml;
End systolic volume / PPT (men) - ≤ 31 ml / m2, women - ≤ 24 ml / m2;

Indicators of diastolic and systolic volume and size can increase in diseases of the myocardium, heart failure, as well as in congenital and acquired heart defects.

Indicators of myocardial mass

The mass of the LV myocardium can increase with thickening of its walls (hypertrophy). Hypertrophy can be caused by various diseases cardiovascular system: arterial hypertension, mitral defects, aortic valve, hypertrophic cardiomyopathy.

Right ventricle. Basal diameter - ≤ 41 mm;

End diastolic volume (EDV) RV / BST (men) ≤ 87 ml / m2, women ≤ 74 ml / m2;

End systolic volume (CSV) of the RV / PPT (men) - ≤ 44 ml / m2, women - 36 ml / m2;

RV wall thickness - ≤ 5 mm.

Interventricular septum. The thickness of the IVS in men in mm - ≤ 10, in women - ≤ 9;

4 Valves

To assess the condition of the valves in echocardiography, parameters such as valve area and average pressure gradient are used.

5 Vessels

Blood vessels of the heart

Pulmonary artery. Pulmonary artery (PA) diameter - ≤ 21 mm, PA acceleration time - ≥110 ms. A decrease in the lumen of the vessel indicates stenosis or pathological narrowing of the pulmonary artery. Systolic pressure ≤ 30 mm Hg, mean pressure ≤ mm Hg; An increase in pressure in the pulmonary artery, exceeding the permissible limits, indicates the presence of pulmonary hypertension.

Inferior vena cava. The diameter of the inferior vena cava (IVC) - ≤ 21 mm; An increase in the inferior vena cava in diameter can be observed with a significant increase in the volume of the right atrium (RA) and a weakening of its contractile function. This condition can occur with narrowing of the right atrioventricular opening and with insufficiency of the tricuspid valve (TC).

In other sources, you can find more detailed information about the remaining valves, large vessels, as well as calculations of indicators. Here are some of them that were missing above:

Ejection fraction according to Simpson - norm ≥ 45%, according to Teicholz - ≥ 55%. Simpson's method is used more often because it is more accurate. According to this method, the entire LV cavity is conditionally divided into a certain number of thin discs. The EchoCG operator takes measurements at the end of systole and diastole. The Teicholz method for determining the ejection fraction is simpler, however, if there are asynergic zones in the LV, the obtained data on the ejection fraction are inaccurate.
The concept of normokinesis, hyperkinesis and hypokinesis. Such indicators are assessed by the amplitude of the interventricular septum and the posterior wall of the LV. Normally, the vibrations of the interventricular septum (IVS) are in the range of 0.5-0.8 cm, for the posterior wall of the LV - 0.9-1.4 cm. If the range of motion is less than the indicated numbers, they speak of hypokinesis. In the absence of movement - akinesis. There is also a concept of dyskinesia - the movement of the walls with a negative sign. With hyperkinesis, the indicators exceed normal values. Asynchronous movement of the LV walls may also occur, which is often found in violation of intraventricular conduction, atrial fibrillation (AF), and an artificial pacemaker.

Heartbeat: performance indicators and the norm by age

The predominance of the potential of the left ventricle: norm or pathology?

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Ejection fraction of the left ventricle of the heart: norms, reasons for a decrease and high, how to increase

What is ejection fraction and why should it be assessed?

Ejection fraction of the heart (EF) is a measure of the volume of blood expelled by the left ventricle (LV) at the time of its contraction (systole) into the aortic lumen. EF is calculated based on the ratio of the volume of blood ejected into the aorta to the volume of blood in the left ventricle at the time of its relaxation (diastole). That is, when the ventricle is relaxed, it contains blood from the left atrium (end diastolic volume - EDV), and then, contracting, it pushes part of the blood into the aortic lumen. This part of the blood is the ejection fraction, expressed as a percentage.

The ejection fraction of blood is a value that is technically easy to calculate, and which has a fairly high information content regarding the contractility of the myocardium. The need for prescribing cardiac drugs largely depends on this value, and the prognosis for patients with cardiovascular insufficiency is also determined.

The closer the patient's LV ejection fraction to normal values, the better his heart contracts and the more favorable the prognosis for life and health. If the ejection fraction is much lower than normal, then the heart cannot contract normally and provide blood to the entire body, and in this case, the heart muscle should be supported with medications.

How is ejection fraction calculated?

This indicator can be calculated using the Teicholz or Simpson formula. The calculation is carried out using a program that automatically calculates the result depending on the end systolic and diastolic volumes of the left ventricle, as well as its size.

The calculation according to the Simpson method is considered more successful, since according to Teicholz, small areas of the myocardium with impaired local contractility may not enter the section of the study with two-dimensional Echo-KG, while with the Simpson method, larger sections of the myocardium fall into the section of the circle.

Despite the fact that the Teicholz method is used on outdated equipment, modern ultrasound diagnostic rooms prefer to evaluate the ejection fraction using the Simpson method. The results obtained, by the way, may differ - depending on the method by values within 10%.

Normal EF values

The normal value of the ejection fraction differs from person to person, and also depends on the equipment on which the study is carried out and on the method by which the fraction is calculated.

The average values are approximately 50-60%, the lower limit of the norm according to the Simpson formula is not less than 45%, according to the Teicholz formula - not less than 55%. This percentage means that exactly this amount of blood in one heartbeat must be pushed into the aortic lumen by the heart in order to ensure adequate oxygen delivery to the internal organs.

35-40% speak about neglected heart failure, even lower values are fraught with transient consequences.

In children in the neonatal period, EF is at least 60%, mainly 60-80%, gradually reaching the usual normal values as they grow.

Of the deviations from the norm, more often than an increased ejection fraction, there is a decrease in its value due to various diseases.

If the indicator is reduced, it means that the heart muscle cannot contract enough, as a result of which the volume of expelled blood decreases, and the internal organs, and, first of all, the brain, receive less oxygen.

Sometimes, in the conclusion of echocardioscopy, one can see that the EF value is higher than the average values (60% or more). As a rule, in such cases, the indicator is no more than 80%, since a larger volume of blood in the left ventricle is due to physiological characteristics will not be able to expel into the aorta.

As a rule, high EF is observed in healthy individuals in the absence of other cardiological pathologies, as well as in athletes with trained heart muscle, when the heart contracts with greater force with each beat than in an ordinary person, and expels a larger percentage of the blood it contains into the aorta.

In addition, if the patient has LV myocardial hypertrophy as a manifestation of hypertrophic cardiomyopathy or arterial hypertension, increased ejection fraction may indicate that the heart muscle can still compensate for incipient heart failure and seeks to expel as much blood as possible into the aorta. As heart failure progresses, EF gradually decreases, therefore, for patients with clinically manifested CHF, it is very important to perform echocardioscopy in dynamics in order not to miss a decrease in EF.

Causes of the decreased ejection fraction of the heart

The main reason for the violation of the systolic (contractile) function of the myocardium is the development of chronic heart failure (CHF). In turn, CHF arises and progresses due to diseases such as:

Ischemic heart disease - a decrease in blood flow through the coronary arteries, which supply oxygen to the heart muscle itself,
Postponed myocardial infarctions, especially large-focal and transmural (extensive), as well as repeated, as a result of which normal muscle cells of the heart after a heart attack are replaced by scar tissue that does not have the ability to contract - postinfarction cardiosclerosis is formed (in ECG description can be seen as an acronym for PEAKS),

Decreased ejection fraction due to myocardial infarction (b). The affected areas of the heart muscle cannot contract

Most common reason decrease in cardiac output are acute or postponed myocardial infarctions, accompanied by a decrease in global or local contractility of the left ventricular myocardium.

Symptoms of a decreased ejection fraction

All symptoms that can be suspected of a decrease in the contractile function of the heart are due to CHF. Therefore, the symptomatology of this disease comes out on top.

However, according to the observations of practicing doctors of ultrasound diagnostics, the following is often observed - in patients with pronounced signs of CHF, the ejection fraction indicator remains within the normal range, while in those with no obvious symptoms, the ejection fraction indicator is significantly reduced. Therefore, despite the absence of symptoms, patients with heart disease must undergo echocardioscopy at least once a year.

So, the symptoms that make it possible to suspect a violation of myocardial contractility include:

Attacks of shortness of breath at rest or during physical exertion, as well as in the supine position, especially at night,
The load that provokes the onset of shortness of breath can be different - from significant, for example, walking on foot for long distances (sick), to minimal everyday activity, when it is difficult for the patient to perform the simplest manipulations - cooking, tying laces, walking to the next room, etc. d,
Weakness, fatigue, dizziness, sometimes loss of consciousness - all this indicates that the skeletal muscles and the brain are receiving little blood,
Swelling on the face, legs and feet, and in severe cases - in the internal cavities of the body and throughout the body (anasarka) due to impaired blood circulation through the vessels of the subcutaneous fat, in which fluid retention occurs,
Pain in the right half of the abdomen, an increase in the volume of the abdomen due to fluid retention in abdominal cavity(ascites) - occur as a result of venous stasis in the hepatic vessels, and long-term stagnation can lead to cardiac (cardiac) cirrhosis of the liver.

In the absence of proper treatment systolic dysfunction myocardium, such symptoms progress, increase and are more and more difficult to tolerate by the patient, therefore, if even one of them occurs, you should consult a general practitioner or cardiologist.

When is treatment for a reduced ejection fraction required?

Of course, not a single doctor will offer you to treat a low rate obtained from an ultrasound of the heart. First, the doctor must identify the cause of the reduced EF, and then prescribe treatment for the causative disease. Depending on it, the treatment may differ, for example, taking nitroglycerin preparations for ischemic disease, surgical correction of heart defects, antihypertensive drugs for hypertension, etc. It is important for the patient to understand that if there is a decrease in the ejection fraction, it means that heart failure really develops and it is necessary to follow the doctor's recommendations for a long time and meticulously.

How to increase the reduced ejection fraction?

In addition to drugs that affect the causative disease, the patient is prescribed drugs that can improve myocardial contractility. These include cardiac glycosides (digoxin, strophanthin, korglikon). However, they are prescribed by a strictly attending physician and their independent uncontrolled use is unacceptable, since poisoning may occur - glycosidic intoxication.

To prevent overload of the heart with volume, that is, excess fluid, adherence to a diet with a restriction of table salt to 1.5 g per day and with a restriction of the fluid drunk to 1.5 liters per day is shown. Diuretics (diuretics) are also successfully used - diacarb, diuver, veroshpiron, indapamide, torasemide, etc.

To protect the heart and blood vessels from the inside, drugs with so-called organoprotective properties are used - ACE inhibitors... These include enalapril (Enap, Enam), perindopril (prestarium, prestans), lisinopril, captopril (Capoten). Also, among the drugs with similar properties, ARA II inhibitors are widespread - losartan (Lorista, Lozap), valsartan (Valz), etc.

The treatment regimen is always selected individually, but the patient must be prepared for the fact that the ejection fraction does not return to normal immediately, and the symptoms may bother for some time after the start of therapy.

In some cases, the only method to cure the disease that caused the development of CHF is surgical. Operations may be needed to replace valves, to install stents or coronary shunts, to install a pacemaker, etc.

However, in the case of severe heart failure (III-IV functional class) with extremely low ejection fraction, surgery may be contraindicated. For example, a contraindication to mitral valve replacement is a decrease in EF of less than 20%, and to implantation of a pacemaker - less than 35%. Nevertheless, contraindications to operations are revealed on a face-to-face examination by a cardiac surgeon.

Prophylaxis

The prophylactic focus on the prevention of cardiovascular diseases leading to a low ejection fraction remains especially relevant in today's environmentally unfavorable environment, in the era of a sedentary lifestyle at computers and eating unhealthy foods.

Even on this basis, we can say that frequent outdoor recreation outside the city, healthy eating, adequate physical activity (walking, light jogging, exercise, gymnastics), rejection of bad habits - all this is the key to long-term and correct functioning of the cardiovascular system with normal contractility and fitness of the heart muscle.

Symptoms of the indicator going beyond normal limits, principles of treatment and prognosis.

The ejection fraction (EF) is the ratio of the stroke volume (blood that enters the aorta in one contraction of the heart muscle) to the end-diastolic volume of the ventricle (blood that accumulates in the cavity during the period of relaxation, or diastole, of the myocardium). This value is multiplied by 100% and the final value is obtained. That is, this is the percentage of blood that pushes out the ventricle during systole, of the total volume of fluid it contains.

Under conditions of physiological rest, the normal value of EF is considered to be 50–75%, with physical exertion in healthy people, it increases to 80–85%. There is no further increase, since the myocardium cannot eject all the blood from the ventricular cavity, which will lead to cardiac arrest.

Considering that the reason for the decrease in the volume of left ventricular ejection is its systolic insufficiency (as the outcome of many chronic pathologies of the heart and blood vessels), it is impossible to completely cure this condition. Treatment is carried out that supports the myocardium and is aimed at stabilizing the state at one level.

Features of the indicator

The ejection fraction does not depend on the sex of the person.
With age, a physiological decrease in the indicator is noted.
Low ejection fraction may be an individual norm, but less than 45% is always considered pathological.
All healthy people have an increase in value with an increase in heart rate and blood pressure.
The norm of the indicator when carrying out measurements by radionucleic angiography is considered to be 45–65%.
For measurement, use the formulas of Simpson or Teicholz, normal values, depending on the method used, fluctuate up to 10%.
A critical level of decrease of 35% or less is a sign of irreversible changes in myocardial tissues.
For children in the first years of life, higher rates of 60–80% are characteristic.
The indicator is used to determine the prognosis of any cardiovascular disease in patients.

Reasons for the decrease in the indicator

All influences and diseases that have a negative effect on the myocardium lead to such violations.

Acute myocardial infarction

Cicatricial changes in the heart tissue (cardiosclerosis)

Painless form of ischemia

Tachy and bradyarrhythmias

Ventricular wall aneurysm

Endocarditis (changes in the inner lining)

Pericarditis (bursa disease)

Congenital disorders of the normal structure or defects (violation of the correct location, a significant decrease in the lumen of the aorta, pathological connection between large vessels)

Aneurysm of any part of the aorta

Aortoarteritis (damage by cells of their own immunity of the walls of the aorta and its branches)

Pulmonary thromboembolism

Diabetes mellitus and impaired glucose absorption

Hormone-active tumors of the adrenal glands, pancreas (pheochromocytoma, carcinoid)

Stimulating narcotic drugs

Symptoms of a decrease in the indicator

The manifestations of a decrease in the indicator are distributed according to the frequency of occurrence from the most frequent to the rarer:

significant loss of strength and fatigue from the usual stress;
violation of breathing by the type of increase in frequency, up to attacks of suffocation;
breathing problems worse when lying down;
collaptoid states and loss of consciousness;
changes in vision (darkening in the eyes, "flies");
pain syndrome in the projection of the heart of varying intensity;
an increase in the number of heart contractions;
swelling of the legs and feet;
accumulation of fluid in the chest and abdomen;
a gradual increase in the size of the liver;
progressive weight loss;
episodes of impaired coordination and gait;
periodic decrease in sensitivity and active mobility in the limbs;
discomfort, moderate pain syndrome in the projection of the abdomen;
unstable stools;
bouts of nausea;
vomiting mixed with blood;
blood in the stool.

Treatment with a decrease in the indicator

The ejection fraction less than 45% is a consequence of changes in the functionality of the heart muscle against the background of the progression of the underlying disease-cause. A decrease in the indicator is a sign of irreversible changes in the tissues of the myocardium, and the possibility of a complete cure is out of the question. All therapeutic measures are aimed at stabilizing pathological changes at their early stage and improving the patient's quality of life at a later stage.

The complex of treatment includes:

correction of the main pathological process;
therapy of left ventricular failure.

This article is devoted directly to left ventricular ejection fraction and the types of its violation, therefore, further we will focus only on this part of the treatment.

Ejection fraction of the heart

1 An important diagnostic method

Ultrasound examination of the heart

Echocardiographic examination of the cardiovascular system is a very important and, moreover, a fairly affordable diagnostic method. In some cases, the method is the "gold standard", allowing you to verify a particular diagnosis. In addition, the method allows you to identify latent heart failure, which does not manifest itself during intense physical exertion. Echocardiographic (normal) readings may vary slightly depending on the source. We present the guidelines proposed by the American Echocardiography Association and the European Association for Cardiovascular Imaging from 2015.

2 Ejection fraction

Healthy ejection fraction and pathological (less than 45%)

Right ventricle. The norm of the ejection fraction for the right ventricle (RV) is ≥ 45%.

3 Dimensions of the chambers of the heart

The size of the chambers of the heart is a parameter that is determined in order to exclude or confirm overload of the atria or ventricles.

Left atrium. The norm of the diameter of the left atrium (LA) in mm for men is ≤ 40, for women ≤ 38. An increase in the diameter of the left atrium may indicate heart failure in the patient. In addition to the LA diameter, its volume is also measured. The norm of LA volume for men in mm3 is ≤ 58, for women ≤ 52. The LA size increases with cardiomyopathies, mitral valve defects, arrhythmias (heart rhythm disturbances), congenital heart defects.

Right atrium. For the right atrium (RP), as well as for the left atrium, the size (diameter and volume) is determined by echocardiography. Normally, the diameter of the PCB is ≤ 44 mm. The volume of the right atrium is divided by the body surface area (BSA). For men, the normal ratio is the volume of PP / PPT ≤ 39 ml / m2, for women - ≤33 ml / m2. The size of the right atrium can increase with failure of the right heart. Pulmonary hypertension, pulmonary embolism, chronic obstructive pulmonary disease and other diseases can cause right atrial failure.

ECHO Cardiography (ultrasound of the heart)

Left ventricle. For the ventricles, their own parameters have been introduced regarding their sizes. Since the practicing physician is interested in the functional state of the ventricles in systole and diastole, there are corresponding indicators. The main indicators of dimensions for the LV:

Diastolic size in mm (men) - ≤ 58, women - ≤ 52;
Diastolic size / PPT (men) - ≤ 30 mm / m2, women - ≤ 31 mm / m2;
End diastolic volume (men) - ≤ 150 ml, women - ≤ 106 ml;
End-diastolic volume / PPT (men) - ≤ 74 ml / m2, women - ≤61 ml / m2;
Systolic size in mm (men) - ≤ 40, women - ≤ 35;
End systolic volume (men) - ≤ 61 ml, women - ≤ 42 ml;
End systolic volume / PPT (men) - ≤ 31 ml / m2, women - ≤ 24 ml / m2;

Indicators of diastolic and systolic volume and size can increase in diseases of the myocardium, heart failure, as well as in congenital and acquired heart defects.

Indicators of myocardial mass

The mass of the LV myocardium can increase with thickening of its walls (hypertrophy). The cause of hypertrophy can be various diseases of the cardiovascular system: arterial hypertension, mitral and aortic valve defects, hypertrophic cardiomyopathy.

Right ventricle. Basal diameter - ≤ 41 mm;

End diastolic volume (EDV) RV / BST (men) ≤ 87 ml / m2, women ≤ 74 ml / m2;

End systolic volume (CSV) of the RV / PPT (men) - ≤ 44 ml / m2, women - 36 ml / m2;

RV wall thickness - ≤ 5 mm.

Interventricular septum. The thickness of the IVS in men in mm - ≤ 10, in women - ≤ 9;

4 Valves

To assess the condition of the valves in echocardiography, parameters such as valve area and average pressure gradient are used.

5 Vessels

Blood vessels of the heart

In other sources, you can find more detailed information about the remaining valves, large vessels, as well as calculations of indicators. Here are some of them that were missing above:

Ejection fraction according to Simpson - norm ≥ 45%, according to Teicholz - ≥ 55%. Simpson's method is used more often because it is more accurate. According to this method, the entire LV cavity is conditionally divided into a certain number of thin discs. The EchoCG operator takes measurements at the end of systole and diastole. The Teicholz method for determining the ejection fraction is simpler, however, if there are asynergic zones in the LV, the obtained data on the ejection fraction are inaccurate.
The concept of normokinesis, hyperkinesis and hypokinesis. Such indicators are assessed by the amplitude of the interventricular septum and the posterior wall of the LV. Normally, the vibrations of the interventricular septum (IVS) are in the range of 0.5-0.8 cm, for the posterior wall of the LV - 0.9-1.4 cm. If the range of motion is less than the indicated numbers, they speak of hypokinesis. In the absence of movement - akinesis. There is also a concept of dyskinesia - the movement of the walls with a negative sign. With hyperkinesis, the indicators exceed normal values. Asynchronous movement of the LV walls may also occur, which is often found in violation of intraventricular conduction, atrial fibrillation (AF), and an artificial pacemaker.

Cardiac output: the rate and causes of deviation

When the patient receives the test results, he tries to figure out on his own what each received value means, how critical the deviation from the norm is. An important diagnostic value is the cardiac output indicator, the rate of which indicates a sufficient amount of blood ejected into the aorta, and the deviation indicates an impending heart failure.

Assessment of the ejection fraction of the heart

When a patient comes to the clinic with complaints of pain in the heart, the doctor will prescribe a full diagnosis. A patient who encounters this problem for the first time may not understand what all the terms mean, when certain parameters are increased or decreased, how they are calculated.

The ejection fraction of the heart is determined with the following patient complaints:

Indicative for the doctor will be biochemical analysis blood and electrocardiogram. If the data obtained is not enough, ultrasound, Holter monitoring of the electrocardiogram, and bicycle ergometry are performed.

The ejection fraction is determined by the following heart examinations:

isotope ventriculography;
radiopaque ventriculography.

The ejection fraction is not a difficult indicator to analyze, the data is shown even by the simplest ultrasound machine. As a result, the doctor receives data showing how efficiently the heart works with each heartbeat. During each contraction, a certain percentage of the blood is expelled from the ventricle into the vessels. This volume is designated by the ejection fraction. If from 100 ml of blood in the ventricle, 60 cm were delivered to the aorta, then cardiac output was 60%.

The work of the left ventricle is considered indicative, since blood from the left side of the heart muscle enters the systemic circulation. If failures in the work of the left ventricle are not detected in time, then there is a risk of getting heart failure. A reduced cardiac output indicates the inability of the heart to contract at full strength, therefore, the body is not provided with the required volume of blood. In this case, the heart is supported with medication.

For the calculation, the following formula is used: multiply the stroke volume by the heart rate. The result will show how much blood is pushed out by the heart in 1 minute. The average volume is 5.5 liters.

The formulas for calculating cardiac output are named.

Teicholz's formula. The calculation is performed automatically by the program into which data on the end systolic and diastolic volumes of the left ventricle are entered. The size of the organ also matters.
Simpson's formula. The main difference lies in the possibility of getting into the cut of the circumference of all sections of the myocardium. The study is more revealing, it requires modern equipment.

The data obtained using two different formulas may differ by 10%. The data are indicative for the diagnosis of any disease of the cardiovascular system.

Important nuances when measuring the percentage of cardiac output:

the result is not affected by the gender of the person;
the older the person, the lower the rate of the indicator;
a pathological condition is considered an indicator below 45%;
a decrease in the indicator of less than 35% leads to irreversible consequences;
a reduced rate may be an individual feature (but not lower than 45%);
the indicator rises with hypertension;
in the first few years of life, in children, the ejection rate exceeds the norm (60-80%).

Normal EF values

Normally, more blood flows through the left ventricle, regardless of whether the heart is currently loaded or at rest. Determining the percentage of cardiac output allows you to diagnose heart failure in time.

Normal values of the ejection fraction of the heart

The rate of cardiac output is 55-70%, 40-55% is read as a reduced indicator. If the indicator drops below 40%, heart failure is diagnosed, the indicator below 35% indicates that irreversible heart failure, life-threatening, is possible in the near future.

Exceeding the norm is rare, since the heart is physically unable to expel more blood volume into the aorta than it should be. The indicator reaches 80% in trained people, in particular, athletes, people leading a healthy, active lifestyle.

An increase in cardiac output may indicate myocardial hypertrophy. At this point, the left ventricle tries to compensate initial stage heart failure and pushes blood with greater force.

Even if the body is not affected by external irritating factors, it is guaranteed that 50% of the blood will be expelled with each contraction. If a person is worried about his health, then after the onset of 40 years, it is recommended to undergo an annual check-up with a cardiologist.

The correctness of the prescribed therapy also depends on the determination of the individual threshold. An insufficient amount of processed blood causes a deficiency of the supplied oxygen in all organs, including the brain.

The following pathologies lead to a decrease in the level of cardiac output:

cardiac ischemia;
myocardial infarction;
heart rhythm disturbances (arrhythmia, tachycardia);
cardiomyopathy.

Each pathology of the heart muscle affects the work of the ventricle in its own way. During coronary heart disease, blood flow decreases, after a heart attack, the muscles are covered with scars that cannot contract. Violation of the rhythm leads to a deterioration in conduction, rapid deterioration of the heart, and cardiomyopathy leads to an increase in muscle size.

In the early stages of any disease, the ejection fraction does not change much. The heart muscle adapts to new conditions, the muscle layer grows, small blood vessels... Gradually, the capabilities of the heart are exhausted, muscle fibers are weakened, the volume of absorbed blood decreases.

Other diseases that decrease cardiac output:

angina pectoris;
hypertension;
aneurysm of the ventricular wall;
infectious and inflammatory diseases (pericarditis, myocarditis, endocarditis);
myocardial dystrophy;
cardiomyopathy;
congenital pathologies, violation of the structure of the organ;
vasculitis;
vascular pathology;
hormonal disruptions in the body;
diabetes;
obesity;
tumors of the glands;
intoxication.

A low ejection fraction is indicative of serious cardiac abnormalities. Having received the diagnosis, the patient needs to reconsider the lifestyle, to exclude excessive stress on the heart. Deterioration of the condition can cause emotional distress.

The patient complains of the following symptoms:

increased fatigue, weakness;
the occurrence of a feeling of suffocation;
breathing disorders;
have difficulty breathing while lying down;
visual impairment;
loss of consciousness;
heartache;
increased heart rate;
swelling of the lower extremities.

At more advanced stages and with the development of secondary diseases, the following symptoms occur:

decreased sensitivity of the limbs;
enlargement of the liver;
lack of coordination;
losing weight;
nausea, vomiting, blood in the stool;
abdominal pain;
accumulation of fluid in the lungs and abdomen.

Even if there are no symptoms, this does not mean that the person is not suffering from heart failure. Conversely, pronounced symptoms listed above do not always result in a reduced percentage of cardiac output.

Ultrasound - norms and decoding

Ultrasound examination of the heart

Ultrasound examination gives several indicators by which the doctor judges the state of the heart muscle, in particular, the functioning of the left ventricle.

Cardiac output, the norm is 55-60%;
The size of the atrium of the right chamber, the norm is 2.7-4.5 cm;
Aortic diameter, norm 2.1-4.1 cm;
The size of the atrium of the left chamber, the norm is 1.9-4 cm;
Stroke volume, normasm.

It is important to evaluate not each indicator separately, but the overall clinical picture... If there is a deviation from the norm in the greater or lesser direction of only one indicator, additional research will be required to determine the cause.

Immediately after receiving the results of an ultrasound scan and determining a reduced percentage of cardiac output, the doctor will not be able to determine the treatment plan and prescribe medications. The cause of the pathology should be addressed, not the symptoms of a decreased ejection fraction.

Therapy is selected after a complete diagnosis, definition of the disease and its stage. In some cases, this is drug therapy, sometimes surgery.

First of all, medications are prescribed, aimed at eliminating the root cause of a reduced ejection fraction. An obligatory point of treatment is the intake of drugs that increase the contractility of the myocardium (cardiac glycosides). The doctor selects the dosage and duration of treatment based on the test results, uncontrolled intake can lead to glycosidic intoxication.

Heart failure isn't just treated with pills. The patient should control the drinking regimen, the daily volume of fluid drunk should not exceed 2 liters. Salt must be removed from the diet. Additionally, diuretics, beta-blockers, ACE inhibitors, Digoxin are prescribed. Medications that reduce the heart's need for oxygen will help alleviate the condition.

Modern surgical methods restore blood flow in case of ischemic disease and eliminate severe heart defects. An artificial heart driver can be installed against arrhythmia. The operation is not performed when the percentage of cardiac output drops below 20%.

Prophylaxis

Preventive measures are aimed at improving the state of the cardiovascular system.

Active lifestyle.
Sports activities.
Proper nutrition.
Rejection of bad habits.
Outdoor recreation.
Relief from stress.

Causes of abnormal ejection fraction and treatment methods

The ejection fraction of the heart (EF) is a value that determines the efficiency of the heart. Basically, this indicator is characterized by the amount of blood, which during the contraction period is pushed into the space of the aorta by the left ventricle. In a calm state, the ventricle contains blood from the left atrium inside; at the moment of contraction, it throws part of it into the vessels. Left ventricular ejection fraction is the percentage ratio of the amount of blood expelled into the aorta to the volume of the left ventricle in a relaxed state. The volume of blood ejected, expressed as a percentage, is called the ejection fraction.

Such a concept as the ejection fraction determines the functionality of the left ventricle, since it throws blood into the systemic circulation. With a decrease in the ejection fraction, heart failure develops.

Indications for prescribing ejection fraction studies may be patient complaints:

heartache;
chest pain;
interruptions in the activity of the heart;
tachycardia;
fainting and dizziness;
weakness;
decreased performance;
swelling of the limbs.

First, as a rule, an electrocardiogram and a blood test are prescribed, then Holter monitoring of an electrocardiogram, bicycle ergometry and ultrasound of the heart can be prescribed.

How is PV calculated?

The ejection fraction is easy to calculate and contains enough information about the ability of the myocardium to contract. The use of drugs in the treatment of patients with cardiovascular insufficiency depends on this indicator. A study such as ultrasound of the heart with Doppler ultrasound is widely used to establish the value of the left ventricular ejection fraction.

The ejection fraction can be determined using the Teicholz formula or the Simpson method:

Using M-modal echocardiography (parasternal access), the ventricular ejection fraction is determined by the Teichholz formula (Teichholz L. E., 1976). A small part of the ventricle at the base is subject to research, its length is not taken into account. The formula gives inaccurate results when examining patients with ischemia, when areas with impaired local contractility are present. Using information about the systolic and diastolic volume of the left ventricle and its size, the program automatically calculates the result. The method is used on outdated equipment.
Quantitative two-dimensional echocardiography (apical approach) is a method that is more accurate than the previous one. In modern clinics, ultrasound diagnostics use the Simpson algorithm (Simpson J. S., 1989) or, as it is also called, the disk method. During the study, all significant zones of the myocardium fall into the field of view.

The difference between the results of ejection fraction studies can vary within 10%.

Normal fraction ejection

At the moment of contraction, the human heart pushes more than 50% of the blood into the blood supply system. Heart failure occurs when the level of ejection fraction decreases. Progressive failure of the contractile function of the myocardium may serve as the basis for the development of other changes from the side internal organs.

The ejection fraction rate is 55–70%. At 40–55%, we can say that EF is below normal. Interruptions in the work of the heart occur when the indicator drops to 35%: heart failure occurs. To prevent a decrease in the EF, it is recommended to visit a cardiologist at least once a year, and for people over forty, this is a prerequisite. When examining patients with cardiac pathologies, it is important to determine the minimum value of the left ventricular ejection fraction. The choice of treatment tactics for the patient depends on this.

Why can the EF level be overestimated?

If in the survey results the indicator is 60% or more, this indicates an overestimated level of the ejection fraction. The most high value can reach 80%, the left ventricle is simply unable to discharge more blood into the vessels due to its characteristics. Typically, these results are typical for healthy people without other cardiac abnormalities. And for athletes with a trained heart, whose heart muscle, by contracting with considerable force, is able to expel more blood than usual.

Cardiomyopathy or hypertension can trigger the development of myocardial hypertrophy. In such patients, the heart muscle can still cope with heart failure and compensate for it, trying to expel blood into the systemic circulation. This can be judged by observing an increase in left ventricular ejection fraction.

As heart failure progresses, the ejection fraction slowly decreases. For patients with chronic heart failure, it is extremely important to undergo periodic echocardioscopy in order to observe a decrease in EF.

Ways to Increase Low EF

Chronic heart failure is the main cause of a violation of the systolic (contractile) function of the myocardium, and hence a decrease in the ejection fraction. The development of CHF is facilitated by:

Heart ischemia is a reduced amount of blood in the coronary vessels that supply oxygen to the heart.
Myocardial infarction, its large focal and transmurality. As a result, the replacement of healthy heart cells with scars that are unable to contract.
Diseases caused by irregular heart rhythm due to improper contraction.
Cardiomyopathy is a stretching or enlargement of the heart muscle. It develops as a result of hormonal disruptions, hypertension, heart disease.

Feeling unwell, shortness of breath, swelling of the extremities indicate a low value of the ejection fraction. How to increase the volume of the fraction emitted? To date, in modern medicine, therapy is in the first place among the ways to increase EF. Patients are often seen on an outpatient basis, where the state of the heart, cardiovascular system and drug treatment are examined.

The doctor often prescribes diuretics that can reduce the amount of blood that circulates in the system, and, as a result, the load on the heart. And also glycosides, ACE inhibitors or beta-blockers, which reduce the heart's need for oxygen, increase performance and reduce the energy requirement of the heart muscle.

In extreme cases, due to the dangers of death, such as heart disease or valvular disease, surgery is performed. In all other cases, therapy is indicated. Operations have been developed to restore blood flow in coronary vessels in case of ischemic heart disease and valvular apparatus defects. During the operation, the valves are resected, and prosthetics are performed. Thus, the normalization of the rhythm is achieved, arrhythmia and fibrillation disappear.

Cardiovascular surgery requires the professionalism and experience of surgeons, therefore, operations are performed in cardiology centers.

Prevention of low ejection fraction

If the patient does not have a predisposition to heart disease, then the value of the left ventricular ejection fraction can be successfully maintained in the normal range.

To prevent the norm of the ejection fraction, doctors recommend:

Sports (aerobics), light exercise.
Do not carry weights, go to the gym.
Quitting alcohol and smoking.
Healthy lifestyle.
Intake of food rich in iron.
Reduce salt intake.
Drink 1.5–2 liters of water per day.
Diet.

According to statistics of the twentieth century, people in old age mainly suffered from heart disease. In the XXI century, these pathologies have become significantly "younger". The risk group includes residents of megalopolises who live in conditions with a high content of car exhaust and low - oxygen.

What is heart ejection fraction

Today, due to poor ecology, many people have unstable health. This applies to all organs and systems in human body... Therefore, modern medicine has expanded its methods of studying pathological processes. Many patients wonder what the heart ejection fraction (EF) is. The answer is simple, this condition is the most accurate indicator that can determine the level of performance of the human heart system. More precisely, the strength of the muscle at the time of the organ impact.

Definition

The index of the ejection fraction of the heart can be determined as the percentage of the amount of blood masses that passes through the vessels in the systolic state of the ventricles.

For example, at 100 ml, 65 ml of blood enters the vessel system, respectively, the cardiac output of the heart fraction is 65%. Any deviation in one direction or another is an indicator of the presence of heart disease, requiring immediate treatment.

Healthy heart and heart failure

In most cases, measurements are taken of the left ventricle, because blood masses from it are sent to the systemic circulation. When there is a decrease in the amount of distilled content, it is usually a consequence of heart failure.

Diagnostics such as the left ventricular ejection fraction is prescribed for patients with:

Intense chest pain.
Systematic failures in the work of the body.
Shortness of breath and tachycardia of the heart.
Frequent fainting and dizziness.
Weakness and fatigue.
Decreased performance.

In most cases, during the examination, an ultrasound scan is prescribed ( ultrasonography) heart and cardiogram. These studies enable the level of ejection in the left and right side of the heart. Such a diagnosis is quite informative and available to all patients.

Causes

In fact, the reasons for the low ejection fraction of the heart are malfunctions in the functioning of the organ. Heart failure is considered to be a condition that has arisen as a result of a long-term disruption in the functioning of the system. Inflammatory diseases, malfunctions can lead to this pathology. immune system, genetic and metabolic predisposition, pregnancy and more.

Often the cause of heart failure is the presence of organ ischemia, a previous heart attack, hypertensive crisis, a combination of hypertension and ischemic heart disease, valvular malformations.

Symptoms

Most often, the symptoms of a reduced ejection fraction of the heart are manifested in a malfunction of the organ. To clarify the diagnosis, it is required to undergo a detailed examination and pass a lot of tests.

If necessary, the doctor prescribes a number pharmacological preparations, which can cause an increase in the efficiency of the heart. This applies to patients of any age category from infants to the elderly.

Frequent shortness of breath and pain in the heart - cause abnormalities in the ejection fraction of the heart

Treatment

The most popular treatments for low heart rate ejection fraction are medication. In cases where the main cause of this pathological process is heart failure, then the patient is selected for treatment, taking into account the age and characteristics of the organism.

Diet restrictions are almost always recommended, as well as a reduction in fluid intake. You need to drink no more than 2 liters per day, and then only pure, non-carbonated water. It is worth noting that for the entire period of treatment, it is necessary to almost completely abandon the use of salt in food. A number of diuretics, ACE inhibitors, digoxin, and beta-blockers are prescribed.

All of these funds significantly reduce the volume of circulating blood masses, which accordingly reduces the level of organ function. A number of other drugs are able to reduce the body's need for oxygen, while simultaneously making its functionality the most effective and at the same time less costly. In some advanced cases, surgery is used to restore blood flow in all coronary vessels. A similar method is used for ischemic disease.

In cases of severe defects and pathological processes, only surgery in combination with drug therapy is used as treatment. If necessary, artificial valves are installed that can prevent cardiac arrhythmias and many other heart failures, including fibrillation. Instrumental methods are used as a last resort when drug therapy is unable to eliminate certain problems in the work of the cardiac system.

Norm

To determine the natural rate of heart ejection fraction, a special Simpson or Teicholz table is used. It is worth noting that only after a complete examination, the doctor can establish an accurate diagnosis and, accordingly, prescribe the most adequate treatment.

The presence of any pathological processes in the cardiac system is due to a regular lack of oxygen (oxygen starvation) and nutrients. In such cases, the heart muscles need support.

As a rule, all data are calculated using special equipment capable of detecting the presence of deviations. Most modern specialists, when using ultrasound diagnostics, prefer the Simpson method, which gives the most accurate results. Less commonly used is the Teicholz formula. The choice in favor of one or another diagnostic method is made by the attending physician based on the test results and the patient's state of health. The ejection fraction of the heart should be normal at any age, otherwise failures can be counted as pathology.

The exact result of both methods is considered to be indicators in the range of 50-60%. A slight difference between them is allowed, but not more than 10%. Ideally, the rate of heart fraction in adults is exactly this percentage level. Both methods are considered highly informative. As a rule, the outlier is 45% according to the Simpson table, and 55% according to Teicholz. When the values decrease to 35-40%, this is evidence of an advanced degree of heart failure, which can be fatal.

Normally, the heart should expel at least 50% of the distilled blood. With a decrease in this mark, heart failure occurs, in most cases it is progressive, which affects the development of pathological processes in many internal organs and systems.

The rate of ejection fraction in children varies from 55 to 70%. If its level is below 40-55%, then this already indicates a malfunction in the work of the heart. To prevent such deviations, it is necessary to carry out a preventive examination by a cardiologist.

Ejection fraction of the left ventricle of the heart: norms, reasons for a decrease and high, how to increase

What is ejection fraction and why should it be assessed?

How is ejection fraction calculated?

Normal EF values

The normal value of the ejection fraction differs from person to person, and also depends on the equipment on which the study is carried out and on the method by which the fraction is calculated.

35-40% speak about neglected heart failure, even lower values are fraught with transient consequences.

In children in the neonatal period, EF is at least 60%, mainly 60-80%, gradually reaching the usual normal values as they grow.

Of the deviations from the norm, more often than an increased ejection fraction, there is a decrease in its value due to various diseases.

Sometimes, in the conclusion of echocardioscopy, one can see that the EF value is higher than the average values (60% or more). As a rule, in such cases, the indicator is no more than 80%, since the left ventricle, due to physiological characteristics, cannot expel a larger volume of blood into the aorta.

In addition, if the patient has LV myocardial hypertrophy as a manifestation of hypertrophic cardiomyopathy or arterial hypertension, an increased EF may indicate that the heart muscle can still compensate for incipient heart failure and seeks to expel as much blood as possible into the aorta. As heart failure progresses, EF gradually decreases, therefore, for patients with clinically manifested CHF, it is very important to perform echocardioscopy in dynamics in order not to miss a decrease in EF.

Causes of the decreased ejection fraction of the heart

Ischemic heart disease - a decrease in blood flow through the coronary arteries, which supply oxygen to the heart muscle itself,
Postponed myocardial infarctions, especially large-focal and transmural (extensive), as well as repeated, as a result of which normal muscle cells of the heart after a heart attack are replaced by scar tissue that does not have the ability to contract - postinfarction cardiosclerosis is formed (in the description of ECG it can be seen as an abbreviation PICS),

Decreased ejection fraction due to myocardial infarction (b). The affected areas of the heart muscle cannot contract

The most common cause of a decrease in cardiac output is acute or postponed myocardial infarction, accompanied by a decrease in global or local contractility of the left ventricular myocardium.

Symptoms of a decreased ejection fraction

All symptoms that can be suspected of a decrease in the contractile function of the heart are due to CHF. Therefore, the symptomatology of this disease comes out on top.

So, the symptoms that make it possible to suspect a violation of myocardial contractility include:

Attacks of shortness of breath at rest or during physical exertion, as well as in the supine position, especially at night,
The load that provokes the onset of shortness of breath can be different - from significant, for example, walking on foot for long distances (sick), to minimal everyday activity, when it is difficult for the patient to perform the simplest manipulations - cooking, tying laces, walking to the next room, etc. d,
Weakness, fatigue, dizziness, sometimes loss of consciousness - all this indicates that the skeletal muscles and the brain are receiving little blood,
Swelling on the face, legs and feet, and in severe cases - in the internal cavities of the body and throughout the body (anasarka) due to impaired blood circulation through the vessels of the subcutaneous fat, in which fluid retention occurs,
Pain in the right half of the abdomen, an increase in the volume of the abdomen due to fluid retention in the abdominal cavity (ascites) - occur due to venous stasis in the hepatic vessels, and long-standing stagnation can lead to cardiac (cardiac) cirrhosis of the liver.

In the absence of competent treatment of systolic myocardial dysfunction, such symptoms progress, increase and are more and more difficult to be tolerated by the patient, therefore, if even one of them occurs, you should consult a general practitioner or cardiologist.

When is treatment for a reduced ejection fraction required?

Of course, not a single doctor will offer you to treat a low rate obtained from an ultrasound of the heart. First, the doctor must identify the cause of the reduced EF, and then prescribe treatment for the causative disease. Depending on it, the treatment may differ, for example, taking nitroglycerin drugs for ischemic disease, surgical correction of heart defects, antihypertensive drugs for hypertension, etc. it is necessary to follow the doctor's recommendations for a long time and meticulously.

How to increase the reduced ejection fraction?

To protect the heart and blood vessels from the inside, drugs with so-called organoprotective properties are used - ACE inhibitors. These include enalapril (Enap, Enam), perindopril (prestarium, prestans), lisinopril, captopril (Capoten). Also, among the drugs with similar properties, ARA II inhibitors are widespread - losartan (Lorista, Lozap), valsartan (Valz), etc.

Prophylaxis

Even on this basis, we can say that frequent outdoor recreation outside the city, healthy diet, adequate physical activity (walking, light jogging, exercise, gymnastics), rejection of bad habits - all this is the key to long-term and correct functioning of the cardiac -vascular system with normal contractility and fitness of the heart muscle.

The ejection fraction of the heart is a diagnostic parameter, the numerical value of which indicates the contractility of the myocardium. Ejection means the amount of blood that, at the time of calculation, pushes the ventricle of the heart into the artery, that is, the pumping function of the heart is assessed.

When calculating the ejection fraction, the minute blood volume (MVV) is used, the value of which divided by the heart rate () gives the systolic volume (CO). Determination of IOC and SD indicators is widely used in clinical practice for diagnostic purposes.

The numerical value of the ejection fraction parameter is expressed as a percentage. It is believed that values in the range of 50 - 75 %% are the norm for a healthy person. Physical activity can increase this value by up to 80%.

The ejection fraction is a parameter that measures the amount of blood that the left ventricle expels into the aorta during the systolic phase. The ejection fraction is calculated by the proportion of the volume of blood pushed into the aorta and its volume in the left ventricle during relaxation.

For reference. In other words, during diastole, blood from the left atrium passes into the LV, after which the muscle fibers of the heart chamber contract and eject a certain amount of blood into the main artery of the body. It is this volume as a percentage that is estimated as an indicator of FV.

This parameter is calculated quite simply. It clearly demonstrates the state of the ability of the muscular layer of the heart to contract. The ejection fraction of the heart reveals the need for a person for treatment medicines and has predictive value for people suffering from diseases of the cardiovascular system.

The closer to the normal value of the ejection fraction, the better the patient's ability to contract in the myocardium, which indicates a more favorable prognosis of the disease.

Attention. If the calculated EF value is less than the average parameters, it should be concluded that the myocardium functions with difficulty and does not supply the body with blood sufficiently. In this case, the person needs to be prescribed heart medications.

How the ejection fraction is calculated

For the purpose of calculating the fraction of cardiac output, the Teicholz or Simpson formula is used. The calculation performs special program, automatically giving an assessment, taking into account information about the end systolic and diastolic volumes of the LV and its parameters.

The greatest efficiency of the calculation is obtained by the Simpson's formula, since when using the Teicholz method, data from limited areas of the muscular membrane of the heart with impaired local contraction are often not taken into account. Simpson's technique does not allow such errors, and large areas of the myocardium fall into the section of the study.

Attention. On old devices for research, the Teicholz formula is used, and in new ultrasound diagnostic rooms, the Simpson method is used on modern equipment. It should be borne in mind that the results obtained by these methods may differ from each other by about 10 percent.

Ejection fraction - normal

Since heart ejection fraction rates depend on the equipment and the formula used, the average values are in the range of 50-60 %%. The lowest normal value according to the Simpson method is 45 percent, according to the Teicholz method, the minimum is 55 percent.

This parameter indicates that the heart must throw this amount of blood into the arterial system in order to fully provide the body with oxygen supply.

Attention. A long-term course is signaled by a calculated parameter of 35-40 percent, if the figure is even less, the prognosis of the disease is very unfavorable.

The ejection fraction of the heart in newborns is at least 60 percent, most often the value corresponds to the range from 60 to 80 %%, with the course of growing up, the parameters are equated to the norm.

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Unlike normal values ejection fraction of the heart, as a rule, is to decrease the numbers.

Attention. A reduced value of EF signals that the myocardium is contracted inadequately, which means that the amount of blood ejected into the aorta is less than normal, because of this, oxygen starvation of internal organs, especially the brain, develops.

Sometimes, during echocardioscopy, an ejection fraction parameter is found that is greater than normal. Typically, the EF figure is less than 80%, since an excessive amount of LV blood cannot be pushed out due to physiological features.

Usually, the exceeded parameter of the ejection fraction is found in healthy people who do not suffer from heart disease, in addition, in people who are actively involved in sports. This is due to the fact that athletes have a trained myocardium and contract more strongly, therefore it can push the excess blood volume into the arterial system.

Attention. If the patient has cardiomyopathy left ventricle as a sign of hypertrophy or hypertension, the exceeded parameter of the ejection fraction may signal the inability of the myocardium to compensate for the first phase of heart failure.

In view of this, the myocardium of the heart is trying to push out a large volume of blood. In the course of the development of this ailment, the ejection fraction will decrease, in view of this, patients should regularly undergo an echocardioscopic examination in order not to miss the moment of increased formation of heart failure.

Causes of the decreased ejection fraction of the heart

The primary factor provoking a failure in the ability of the muscular membrane of the heart to contract is the formation of a chronic heart failure.

For the formation of this common disease, the following pathologies become the main factors:

- reduced blood flow through the coronary vessels, which provide oxygen supply to the heart muscle fibers;
myocardial infarctions in the history of the disease, in particular - transmural and with an extensive lesion, in addition - repeated. This pathology causes the replacement of normal cardiomyocytes with cells connective tissue, with a lack of ability to contract;
long-term or often developing failures of heart rate and conduction, this causes the myocardium to work for wear due to uneven and irregular impulses. This phenomenon is characteristic of a constant type of atrial fibrillation, frequent attacks of ventricular extrasystole and increased heart rate, etc.;
cardiomyopathies - a disturbed structure of the heart, which is caused by an increase or stretching of the myocardium, developing due to hormonal imbalance, a long course of hypertension, characterized by high values of blood pressure, cardiac defects, etc.

For reference. The most common factor provoking a decrease in EF is considered to be acute or postponed heart attacks of the myocardial membrane, accompanied by serious failures in the ability of the myocardium to contract.

Symptoms of a decreased ejection fraction

Symptoms indicating that the contractility of the heart muscle is worsening is caused by chronic heart failure. Therefore, it is paramount to pay attention to the signs that have arisen.

Attention. Clinicians have found that quite often in people with bright signs of chronic HF, the number of ejection fraction of the heart corresponds to the middle range, and in patients with asymptomatic course of the pathology, the EF is greatly reduced. It follows from this that even if there are no obvious signs of the disease, people with heart disease need to undergo an echocardioscopic examination every year.

The following signs indicate a failure of the ability of the heart muscle to contract:

Dyspnoea in the normal state or during physical activity, in a supine position at night.
Shortness of breath can be disturbing even when performing simple actions - walking, cooking, changing clothes.
Weakness, high fatigue, dizziness and even loss of consciousness - these phenomena signal oxygen starvation of the brain.
Edema in facial area, on the legs, sometimes even inside the body or throughout the body, which is caused by damage to the blood flow in the vasculature under the skin, where excess fluid accumulates.
Painful sensations on the right side of the body, an enlarged abdomen caused by the accumulated excess fluid in the abdominal cavity, which signals the accumulation of blood in the veins of the liver, and prolonged stagnation can cause cirrhosis of the liver of cardiological origin.

For reference. If proper therapy is not provided in a timely manner, the symptoms intensify and are much worse tolerated, which is why, in the presence of at least one symptom, it is required to visit a qualified specialist.

When is treatment for a reduced ejection fraction required?

Before prescribing the necessary therapy for detecting a decreased heart ejection fraction, it is necessary to determine the cause that has become a factor for its decrease.

Assessment of the ejection fraction of the heart

When a patient contacts a clinic with complaints of pain in, the doctor will prescribe a full diagnosis. A patient who encounters this problem for the first time may not understand what all the terms mean, when certain parameters are increased or decreased, how they are calculated.

The ejection fraction of the heart is determined with the following patient complaints:

heartache;
tachycardia;
dyspnea;
dizziness and fainting;
increased fatigue;
chest pain;
interruptions in the work of the heart;
swelling of the limbs.

A biochemical blood test and an electrocardiogram will be indicative for the doctor. If the data obtained is not enough, ultrasound, Holter monitoring of the electrocardiogram, and bicycle ergometry are performed.

The ejection fraction is determined by the following heart examinations:

isotope ventriculography;
radiopaque ventriculography.

How is ejection fraction calculated?

Teicholz's formula. The calculation is performed automatically by the program into which data on the end systolic and diastolic volumes of the left ventricle are entered. The size of the organ also matters.
Simpson's formula. The main difference lies in the possibility of getting into the cut of the circle of all sections. The study is more revealing, it requires modern equipment.

The data obtained using two different formulas may differ by 10%. The data are indicative for the diagnosis of any disease of the cardiovascular system.

Important nuances when measuring the percentage of cardiac output:

the result is not affected by the gender of the person;
the older the person, the lower the rate of the indicator;
a pathological condition is considered an indicator below 45%;
a decrease in the indicator of less than 35% leads to irreversible consequences;
a reduced rate may be an individual feature (but not lower than 45%);
the indicator rises with hypertension;
in the first few years of life, in children, the ejection rate exceeds the norm (60-80%).

Normal EF values

Normally, more blood flows through, regardless of whether the heart is currently loaded or at rest. Determining the percentage of cardiac output allows you to diagnose heart failure in time.

Normal values of the ejection fraction of the heart

An increase in cardiac output may indicate myocardial hypertrophy. At this point, the left ventricle tries to compensate for the initial stage of heart failure and expels blood with greater force.

The correctness of the prescribed therapy also depends on the determination of the individual threshold. An insufficient amount of processed blood causes a deficiency of supplied oxygen in all organs, including.

Causes of the decreased ejection fraction of the heart

The following pathologies lead to a decrease in the level of cardiac output:

cardiac ischemia;
myocardial infarction;
heart rhythm disturbances (arrhythmia, tachycardia);
cardiomyopathy.

In the early stages of any disease, the ejection fraction does not change much. The heart muscle adapts to new conditions, the muscle layer grows, and small blood vessels are rebuilt. Gradually, the capabilities of the heart are exhausted, muscle fibers are weakened, the volume of absorbed blood decreases.

Other diseases that decrease cardiac output:

angina pectoris;
hypertension;
aneurysm of the ventricular wall;
infectious and inflammatory diseases (pericarditis, myocarditis,);
myocardial dystrophy;
cardiomyopathy;
congenital pathologies, violation of the structure of the organ;
vasculitis;
vascular pathology;
hormonal disruptions in the body;
diabetes;
obesity;
tumors of the glands;
intoxication.

Symptoms of a decreased ejection fraction

The patient complains of the following symptoms:

increased fatigue, weakness;
the occurrence of a feeling of suffocation;
breathing disorders;
have difficulty breathing while lying down;
visual impairment;
loss of consciousness;
heartache;
increased heart rate;
swelling of the lower extremities.

At more advanced stages and with the development of secondary diseases, the following symptoms occur:

decreased sensitivity of the limbs;
enlargement of the liver;
lack of coordination;
losing weight;
nausea, vomiting, blood c;
abdominal pain;
accumulation of fluid in the lungs and abdomen.

Even if there are no symptoms, this does not mean that the person is not suffering from heart failure. Conversely, pronounced symptoms listed above do not always result in a reduced percentage of cardiac output.

Ultrasound - norms and decoding

Ultrasound examination of the heart

Ultrasound examination gives several indicators by which the doctor judges the state of the heart muscle, in particular, the functioning of the left ventricle.

Cardiac output, the norm is 55-60%;
The size of the atrium of the right chamber, the norm is 2.7-4.5 cm;
Aortic diameter, norm 2.1-4.1 cm;
The size of the atrium of the left chamber, the norm is 1.9-4 cm;
Impact volume, norm 60-100 cm3.

It is important to evaluate not each indicator separately, but the overall clinical picture. If there is a deviation from the norm in the greater or lesser direction of only one indicator, additional research will be required to determine the cause.

When is treatment for a reduced ejection fraction required?

Therapy is selected after a complete diagnosis, definition of the disease and its stage. In some cases, this is drug therapy, sometimes surgery.

How to increase the reduced ejection fraction?

Prophylaxis

Preventive measures are aimed at improving the state of the cardiovascular system.

Active lifestyle.
Classes .
Proper nutrition.
Rejection of bad habits.
Outdoor recreation.
Relief from stress.

What is heart ejection fraction:

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The high efficacy of drugs that serve as the basis for the treatment of patients with CHF is confirmed by the results of large randomized trials (Table 1). The role of surgical methods of treating such patients is constantly growing (Fig. 1). Great importance has an outpatient follow-up organization. Although lifestyle measures are considered important, their effect on prognosis has not been proven.

Rice. 1. Algorithm for the treatment of patients with symptomatic HF and decreased ejection fraction. PCT - resynchronization therapy. LVEF - left ventricular ejection fraction.

Source: Dickstein K., Cohen-Solal A., Filippatos G. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) // Eur. Heart J. - 2008. - Vol. 29. - P. 2388-2422.

Table 1

Results from randomized controlled trials * in patients with symptomatic chronic heart failure and low left ventricular ejection fraction

Le- reading, research dove- nie, year public cations	N	Death- ness v first year at pain- ny, accept poor pla- cebo / cont- roll group py	Previous standing other cure nie **	Before- bav- le- niya To tera- fii	OCP, % ***	Pre- dovra- puppy event- tiy on the 1000 pain- ny, semi- longing cure nie ††
Le- reading, research dove- nie, year public cations	N			Before- bav- le- niya To tera- fii	OCP, % ***	Sme vomit	State option on CH	Sme vomit or gosp- tion on WITH N
CON- SEN- SUS, 1987	253	52	Spiro	Ena- lapril 20 mg 2 times in a day	40	146	-	-
SOLVD- T, 1991	25 69	15,7	-	Ena- lapril 20 mg 2 times in a day	16	45	96	108
CIBIS- 2, 1999	26 47	13,2	ACE inhibitors	Bis- prolol 10 mg 1 time in a day	34	55	56	-
MERIT- HF, 1999	39 91	11,0	ACE inhibitors	Metho- prolol 200 mg 1 time in a day	34	36	46	63
COPER- NICUS, 2001	22 89	19,7	ACE inhibitors	Carve- dilol 25 mg 2 times in a day	35	55	65	81
SENIOR S, 2005	21 28	8,5	ACE inhibitors + Spiro	Nebi volol 10 mg 1 time in a day	14	23	0	0
Val- HeFT, 2001	50 10	8,0	ACE inhibitors	Shaft- sartan 160 mg 2 times in a day	13	0	35	33 †††
CHARM- Alter- native, 2003	20 28	12,6	BB	Kande- sartan 32 mg 1 time in a day	23	30	31	60
CHARM- Added 2003	25 48	10,6	ACE inhibitors + BB	Kande- sartan 32 mg 1 time in a day	15	28	47	39
RALES, 1999	16 63	25	ACE inhibitors	Spiro- nolak- tone 25-50 mg 1 time in a day	30	113	95	-
V- HeFT- 1, 1986	45 9	26,4	-	Hydra- lazine 75 mg 4 times in a day. ISDN 40 mg 4 times in a day	34	52	0	-
A- HeFT, 2004	10 50	9,0	ACE inhibitors + BB + spiro	Hydra- lazine 75 mg 3 times in a day. ISDN 40 mg 3 times in a day	-	40	80	-
GISSI- HF, 2008	69 75	9,0	ACE inhibitors + BB + spiro	Omega-3 poly- not on- detective nye fat- ny kis- lots 1 g 1 time in a day	9	18	0	-
DIG, 1997	68 00	11,0	ACE inhibitors	Digo- xine	0	0	79	73
HF- ACTION, 2009	23 31	6,0	ACE inhibitors + BB + spiro	Physi- ical exercise nenia	11	0	-	-
COMPA- NION, 2004	92 5	19,0	ACE inhibitors + BB + spiro	PCT	19	38	-	87
CARE- HF, 2005	81 3	12,6	ACE inhibitors + BB + spiro	PCT	37	97	15 1	184
COMPA- NION, 2004	90 3	19,0	ACE inhibitors + BB + spiro	PCT- ICD	20	74	-	114
SCD- HeFT, 2005	16 76	7,0	ACE inhibitors + BB	ICD	23	-	-	-
REM ATCH, 2001	12 9	75	ACE inhibitors + spiro	Art- is- ny LV	48	282	-	-

Notes (edit).

* Except for actively controlled studies (patients with preserved and low LV fraction were included in the CONSENSUS and SENIORS studies).

** In more than a third of patients, an ACE inhibitor + BB means that an ACE inhibitor is used in almost all patients, and a β-blocker in the majority. Most of the patients were also taking diuretics, and many were taking digoxin (with the exception of the DIG study). Spironolactone was used at the baseline dose in 5% of patients in the Val-HeFT study, 8% in MERIT-HF, 17% in CHARM-Added, 19% in SCD-HeFT, 20% in COPERNICUS, 24% in CHARM Alternative.

*** Relative risk reduction at the primary endpoint. Hospitalization for CHF, patients hospitalized at least 1 time due to worsening CHF; some patients have been hospitalized several times.

† Discontinued early to evaluate benefit.

†† Individual studies could not be conducted to evaluate the effect of treatment on these outcomes.

††† Primary endpoint that also included IV medication for HF for 4 hours or more without hospitalization or resuscitation after cardiac arrest (both added minor numbers).

Designations: BB - β-blocker; PCT-D - PCT device with a defibrillator; CC - cardiovascular; state - hospitalization; ISDN - isosorbide dinitrate; op. - published; spiro - spironolactone; VZHS - auxiliary ventricular system.

Research... A-HeFT (African-American Heart Failure Trial) - Study of HF in African Americans;

CARE HF (Cardiac Resynchronization-Heart Failure) - Cardiac resynchronization in CHF;

COPERNICUS (Carvedilol Prospective Randomized Cumulative Survival) - Study on the use of carvedilol in patients with severe CHF;

CIBIS (Cardiac Insufficiency Bisoprolol Study) - Research on the use of bisoprolol in patients with CHF;

COMPANION (Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure) - Comparison drug treatment, pacing and defibrillation in CHF;

CONSENSUS (Cooperative North Scandinavian Enalapril Survival Study) - Scandinavian study on the use of enalapril in patients with severe heart failure;

DIG (Digitalis Investigation Group) - Research on the use of digoxin;

GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico - Heart Failure) - Italian group for the study of survivors after MI with HF;

HF-ACTION (Heart Failure- A Controlled Trial Investigating Outcomes Exercise TraiNing) - Controlled impact study physical exercise on outcomes;

MERIT-HF (Metoprolol CR / XL Randomized Intervention Trial in congestive heart failure) - Research on the use of a sustained release form of metoprolol in the treatment of patients with CHF;

RALES (Randomized Aldactone Evaluation Study) - Study of the effectiveness of the use of spironolactone (aldactone ♠) in complex treatment patients with severe CHF;

REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) - A randomized study of the use of mechanical assistive systems for the treatment of CHF;

SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure) - Study of the effect of nebivolol on outcomes and readmission in elderly patients with CHF;

SOLVD-T (Studies of Left Ventricular Dysfunction Treatment) - Research on the use of enalapril in the treatment of patients with LV dysfunction and clinically severe CHF;

V-HeFT (Vasodilator Heart Failure Trial) - Application Study vasodilators with CHF;

Val-HeFT (Valsartan Heart Failure Trial) - Study of the use of valsartan in heart failure.

Modified (with permission): McMurray J.J., Pfeffer M.A. Heart failure // Lancet. - 2005. - Vol. 365. - P. 1877-1889.

John McMurray, Mark Petrie, Karl Swedberg, Michel Komajda, Stefan Anker and Roy Gardner

Heart failure

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